This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, January 17, 2015

Weekly Overseas Health IT Links - 17th January, 2015.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Using and comparing data about patient outcomes can help clinicians work to improve care, as well as start conversations about quality improvement, according to a case study published in eGEMs (Generating Evidence & Methods to increase patient outcomes.)

For the study, the researchers at Palo Alto Medical Foundation Research Institute in Palo Alto, California, wanted to create a way to systematically detect or evaluate patient-level outcomes of care. They came up with ExPLORE Clinical Practice--an Internet-based tool on comparative outcomes.

In considering the twists and turns facing the health IT industry in 2015, it's interesting to read through others' forecasts for the coming year.

For instance, InformationWeek Healthcareruns down five trends it foresees for 2015. Among those outlined are increased integration efforts due to consolidation; updated treatment guidelines in the face of new technology; increased patient engagement thanks to better tools and improved pricing transparency; IT being used to monitor training more closely; and analytics being used more to help organizations financially.

Politico, meanwhile, examines the legislative agenda for health IT in 2015, breaking down its preview into six silos: FDA corrections, telemedicine, interoperability, Meaningful Use, privacy and data policies and the future of the 21st Century Cares initiative.

Electronic prescribing is both an expected and preferred technology for older patients, most of whom have to juggle multiple medications on a daily basis, finds a study published in AHIMA’s Perspectives in Health Information Management. ePrescribing is generally perceived by patients as safer, more convenient, and more efficient than paper-based prescriptions, and foster improved communication with healthcare providers that may also contribute to improved medication safety.

The survey of seventy-five older adults in the Pittsburg, Pennsylvania area found that 80% of patients had seen more than one physician in the prior year, with 75% of those patients visiting physicians who used ePrescribing technology. Patients generally took between one and three medications at a time, though 20% took more than six prescriptions, and 53% added between one and three over-the-counter medications to their regimen. Just over half of the participants were familiar with the concept of ePrescribing, though those patients tended to be closer to the younger end of the survey spectrum.

Peter Bernhardt of CommonWell Health Alliance, a group of clinical and health IT organizations, talks about its goal of better data exchange and application integration.

The surprise announcement at HIMSS 2013 was the CommonWell Health Alliance, a group of healthcare organizations seeking to define and promote a national infrastructure with common standards and policies. The coalition's aim is to build interoperability into its software so that providers can work seamlessly within their existing workflow.

CommonWell consists of 14 members, including the 7 founding members. Membership represents acute and ambulatory care EHR suppliers, as well as laboratory, retail pharmacy, perinatal care, and long-term-care health IT systems. The service initially was launched at more than 12 provider sites in four locations: Chicago, Ill.; Elkin and Henderson, N.C.; and Columbia, S.C.

Connecticut's health information exchange, known as Health IT Exchange (HITE-CT), has failed, in large part due to internal mismanagement and bad privacy policies that undermined the public trust, according to Ellen Andrews, executive director of the Connecticut Health Policy Project.

In a December blog post, Andrews said that the HIE wasted $4.3 million in federal grants and accomplished nothing in its four years. She noted that many decisions were made in small committees behind closed doors and presented to the board as done deals. The HIE also refused to adopt a consumer opt-in policy, as used in neighboring states, which would have provided more privacy and security of patient health records.

Connecticut's General Assembly recently repealed the laws establishing the HIE and transferred some of its responsibilities to the Department of Social Services (DSS).

More pediatricians are adopting electronic health records, but many of the systems lack basic functionalities and/or functionalities geared to their specialty, according to a new study in Pediatrics, the official journal of the American Academy of Pediatrics.

The researchers, from Vanderbilt University and elsewhere, sent questionnaires to more than 1,600 pediatricians. They found that the percent of pediatricians using EHRs increased from 58 percent in 2009 to 79 percent in 2012. However, only 31 percent used one with basic functionality, and only 14 percent used one that was fully functional. Many of the systems lacked pediatric functionality, such as weight-based dosing and anthropometric analysis. However, there was an increase in some functionality from 2009 to 2012, mainly in race/ethnicity, electronic prescribing, electronic transmissions, medical history and follow up notes, according to the study.

Tom Delbanco, MD, professor of general medicine and primary care at Harvard Medical School and former chief of general medicine at Beth Israel Deaconess Medical Center, is also co-director of the OpenNotes project, which gives patients access to the clinical notes written by their doctors and nurses.

OpenNotes initially launched in 2010 as a pilot program in three select locations: BIDMC, Geisinger Health System and Harborview Medical Center in Seattle. It soon became apparent that what may have seemed, at first, to be a revolutionary concept had struck a nerve.

Over the past five years, the initiative -- which Delbanco first developed alongside BIDMC researcher Jan Walker, RN -- has grown almost exponentially, finding footholds at some of the largest and most prestigious providers in the country, including the VA, Kaiser Permanente Northwest, Oregon Health & Science University and University of Colorado Health.

Clinicians and patients participating in a pilot implementation of the OpenNotes note-sharing program for mental health treatment at Boston's Beth Israel Deaconess Medical Center say the program has yielded tangible benefits.

As of Dec. 1, 2014, hospital executives said approximately 85,000 BIDMC patients use the hospital's PatientSite portal to manage their care, and about 1,000 of those had access to their mental health notes since the pilot began in March.

Eric Topol, M.D., chief academic officer of Scripps Health in San Diego, is many things. He is a practicing cardiologist, a geneticist, a researcher, and a bestselling author.

In his 2012 book The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare, Topol argues that the healthcare industry is in the beginning phases of its “creative destruction”—a term coined by economist Joseph Schumpeter to describe the revolutionary process by which innovation replaces old industries with new ones. At the heart of this digital-medical revolution, he asserts, is a fundamental shift in who accesses and “owns” medical data and health information—a transfer of power from doctors to consumers.

Now, Topol has come out with a new book, The Patient Will See You Now: The Future of Medicine is in Your Hands, continuing his theme of consumer empowerment. Just as Gutenberg’s printing press spread literature to the masses for the first time in history, he makes the case that smartphones and other mobile devices in the hands of patients will serve to “democratize medicine” giving them control of their data—which has historically been the domain of physicians.

NHS England chief executive Simon Stevens has called for the creation of a digital urgent care ‘front door’ for the health service, as the performance of A&E has become an early general election issue.

However, in a statement accompanying the data he added: “For the future it is clear that we also need a fundamental redesign of the NHS urgent care ‘front door’ – A&E, GPs, 999, 111, out of hours, community care and social services.”

The industry news is full of disparaging talk about the health of the EHR Incentive Programs (i.e., meaningful use), particularly the low number of Stage 2 attestations. While some statistics show that only 35% of the nation's hospitals have met Stage 2 meaningful use requirements, further analysis reveals a different story.

Each month since July 2014, CMS and the Office of the National Coordinator for Health IT update the Health IT Policy Committee on the number of successful Stage 2 attestations. The following day, the same headlines appear with multiple industry analyses and strong reactions that take the low attestation volume as a sign of failing long-term meaningful use viability. These critics say that in November 2014, only 17% of the nation's hospitals successfully demonstrated Stage 2, and most recently that in December 2014 that figure was 35%.

These numbers are being used to demonstrate how difficult it is for the majority of the hospitals to meet Stage 2 requirements and even to make the case that most will not be capable of attesting due to overly stringent requirements. While these numbers are not technically wrong, a closer look reveals a different picture. This is not an attempt to be provocative, but rather we want to provide additional detail to those figures because they do not tell the whole truth about how well hospitals have fared in Stage 2.

Scott Mace, for HealthLeaders Media , January 7, 2015

Healthcare leaders are developing policies to address the continued growth of "bring your own device" and "bring your own technology" use.

This article appears in the December 2014 issue of HealthLeaders magazine.

Even as data breaches proliferate, healthcare workers are carrying ever more digital devices and tapping into consumer-oriented cloud services, causing no end of challenges for healthcare leadership.

The lure of the latest smartphone or tablet, or wearable devices such as Google Glass, is irresistible to healthcare staff. A major strategy of healthcare leaders is to get out in front of the parade and offer technology and impose policies that accommodate the new devices and technology services, but with appropriate oversight.

AMIA congratulates the following 331 physicians in the 2014 class of board-certified clinical informatics subspecialists. The candidates sat for a board exam in October 2014 administered by either the American Board of Preventive Medicine (ABPM) or the American Board of Pathologists (ABP).

The total number of currently board-certified clinical informatics diplomats is 785. The subspecialty is open to board certified physicians in all 24 specialties.

Although much attention has been given to the benefits of electronic health records, EHRs pose serious challenges regarding the privacy of sensitive health information for minor adolescents and parents.

That is the opinion of researchers at Columbia University’s Mailman School of Public Health, published in a Jan. 6 viewpoint article in JAMA, the journal of the American Medical Association.

In the piece, Ronald Bayer, Robert Klitzman, M.D., and John Santelli, M.D., discuss two threats to confidentiality created by EHRs—the possibility of disclosure to parents of health information that the adolescent may wish to keep private, and disclosure to the adolescent of information that parents may wish to keep private.

For the millions of women trying to conceive at any given time, a new, novel technology that detects fertility levels via a wireless sensor may just be the big game changer.

The personal, self-inserted sensor ring, which was just named winner of the mHealth Summit 2014 Venture+ Forum pitch competition, detects subtle changes that occur in the body prior to ovulation, changes that traditional methods have been often unable to detect. Sensor data from the ring is then sent as an alert to a woman's smartphone notifying her when she is most fertile.

And in July, FTC Commissioner Julie Brill spoke about how consumers should be given more choices from developers when it comes to data sharing by smartphone apps gathering health information.

That trend continued Tuesday at the International Consumer Electronics Show in Las Vegas, where FTC Chairwoman Edith Ramirez spoke about privacy protection, including for health data. Ramirez noted, for instance, that while the Internet of Things has the potential to improve global health, the risks are massive.

A new survey of physicians by Healthcare IT News' sister site finds that 55 percent of them won't attest to Stage 2 meaningful use this year. It's "almost impossible" says one specialist polled by Medical Practice Insider.

"The following sentence is false 100 percent of the time: 'We completed meaningful use stages 1 and 2 and as a consequence the care we provide for our patients has improved,'" said another skeptical doc – one of nearly 2,000 polled by MPI in partnership with SERMO.

The U.S. patient monitoring market is projected to grow to more than $5 billion by 2020, thanks to double-digit growth over the next five years in the telehealth market, according to iData Research.

By 2020, the firm predicts that telehealth for disease conditions management will account for more than half of the total telehealth market, fueled by the demand for customized healthcare solutions, increased chronic illness among an aging population, and strained healthcare budgets.

In addition, market growth is anticipated to be “further bolstered as awareness and implementation of standards for reimbursement and adoption of this type of care management increase,” while both public and private organizations are expected to continue to budget more funds for telehealth expenditures during that timeframe.

There is growing interest in the health care information technology community in an emerging data exchange technology known as FHIR (pronounced “fire”).

FHIR, or Fast Health Interoperability Resources, is a proposed interoperability standard developed by the health care IT standards body known as HL7. Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information.

Stakeholders from across the HIT ecosystem are actively exploring, experimenting and testing FHIR. Part of the enthusiasm surrounding FHIR is due to the elegant simplicity of the technology.

There is a financial challenge; there will be a general election. Once the election is over, debate will start in earnest about the future shape of the NHS; and how IT can support the changes needed to improve efficiency and reduce demand by improving health.

That will throw up other controversies; such as where open source fits and whether confidentiality can be maintained. Great leaders will be needed; including new clinical leaders. Sam Sachdeva asks fifteen IT directors, suppliers, analysts and other observers of the healthcare IT scene for their predictions for 2015; and finds they are expecting another busy year.

Even as healthcare providers embrace electronic health records, it's time they re-evaluated their policies for providing patients with access to their medical records, according to research published at Perspectives on Health Information Management.

The research is based on survey responses of 313 members of the American Health Information Management Association.

Despite the adoption of EHRs and portals through which patients can view their records, many organizations still charge patients for that access. In fact, 52.6 percent of respondents said they charge patients for electronic copies of their medical records--such as via a flash drive or DVD--and 64.7 percent charge patients for paper copies. Charges for paper copies generally were by page, with 65 percent reporting that they charge less than $1 per page.

Researchers used nationally representative transactional data from Surescripts from July 2012 to December 2013 to examine electronic prescribing of controlled substances trends.

They found the number of EPCS increased from 1,535 to 52,423, growing an average of 3,000 scripts every month during the study period. At the start of the study, 0.05 percent of clinicians on Surescripts network were prescribing controlled substances electronically. By the end, 1 percent prescribed them.

Scott Mace, for HealthLeaders Media , January 6, 2015

The FDA's job may need clarification as technology changes. Fitness devices are becoming more intelligent and will soon produce data that approaches medical advice.

Two years ago, at the end of my on-site roundup of the building digital health excitement at the International CES show, I wrote about Scanadu, a company developing a noninvasive vital sign reader called the Scout. At the time, Scanadu's founders showed their prototype at a table at one of the off-floor CES press events. It was to my knowledge one of the only announced products at the show waiting for FDA clearance before going on sale.

Today, two years later, Scanadu still doesn't have FDA clearance, and you can't buy the Scout on the company's website. It's a shame, really. The product is more elegantly designed than many consumer electronics products, appears to be simple to use, and provides a lot of valuable biometric information to someone possessing one.

The most common patient care intervention, issuing a prescription[1], is fraught with continuing challenges for patients, their caregivers, and practitioners. Patients rely on medications across a continuum of care, with expectations for self-management[2]; some experience unintended problems along the way. For older patients, such problems often result in emergency hospitalizations[3], many of which could be prevented.

Historically, integration to support safe and appropriate medicine use across the U.S. health care ecosystem has been sporadic, including within our siloed Medicare Part D benefit[4]. Other countries, however, are well on their way to better integration.

In the following blog post, we share examples from the United Kingdom and Australia. Fortunately, U.S. practitioners who recognize optimizing medication use as an essential element of population health can look to several recent federal opportunities to support their efforts.

With the influenza outbreak in the U.S. now officially considered an epidemic by the Centers for Disease Control and Prevention, the jury is still out on whether the performance of Google Flu Trends is up to snuff.

Launched in the U.S. in 2008, Google Flu Trends uses aggregated web search data to estimate flu activity in near real-time. Estimating the start, peak, and duration of each flu season, the company claims that Google search terms are good indicators of flu levels and that their online service is more finely grained geographically and is more immediate—up to 1-2 weeks ahead of traditional methods such as the CDC’s official reports. At the same time, Google Flu Trends emphasizes that it “is not designed to be a replacement for traditional surveillance networks or supplant the need for laboratory-based diagnoses and surveillance."

The U.S. Food and Drug Administration's Mini-Sentinel program, used for medical product safety monitoring, is ready to move to the full-scale system, according to Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research.

"The Mini-Sentinel pilot program has established secure access to the electronic healthcare data of more than 178 million patients across the country, enabling researchers to evaluate a great deal of valuable safety information," Woodcock writes in a recent blog post.

The market for IT outsourcing in healthcare and life sciences is expected increase at an 8.6 percent compound annual growth rate through 2019, with the adoption of cloud-based services among the major trends, according to global research firm TechNavio.

Organizations might be outsourcing just a few applications or their whole IT operations, relying on managed services to eliminate the need for an in-house IT staff. IT outsourcing helps healthcare providers to deploy business applications rapidly and focus on their core business.

IBM is researching the application of cognitive computing to analyse dermatological images of skin lesions with the goal of assisting clinicians in the identification of various cancerous disease states.

Cognitive computing technology can be used to learn and identify specific patterns in medical images, has the potential to increase the number of cases detected and help clinicians make earlier diagnoses.

The research, which is part of a collaborative effort with Memorial Sloan Kettering, is investigating the automated analysis of skin imaging.

MEDITECH's EHR is equipped with an early warning detection system recognizing patients at risk for sepsis.

The system is embedded into the clinical workflow. When clinicians are inputting information and their assessments into the EHR, the system monitors patient information. The system will then alert clinicians if a patient meets the criteria for potential sepsis.

The healthcare industry must develop a national patient matching strategy based on standardized data elements as HIE expands, AHIMA says.

A dearth of standardized data elements is preventing EHR interoperability and widespread health information exchange (HIE) along the care continuum, states an article published recently in AHIMA’s Perspectives in Health Information Management, and is contributing to the inability to properly match patients across disparate systems. While better patient matching has been identified by the ONC as a short-term goal for the healthcare industry, the lack of a nation-wide data standardization strategy may limit efforts to improve interoperability, health information exchange, and improved data governance.

Health IT interest, adoption and use saw big strides in 2014. But debate surrounding federal health IT initiatives, regulation and the future of the Office of the National Coordinator for Health IT also grew over the last year.

For thefourth yearin a row, iHealthBeat asked a variety of stakeholders to weigh in on health IT progress, disappointments and hopes for the future.

Each health IT expert answered three questions about the most significant health IT development in 2014, the biggest disappointment in the past year and how the remaining barriers to widespread health IT adoption should be addressed in 2015.

Before finding out what the experts think, here's a quick look back at 2014.

The policy known as meaningful use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers.

Because I believe that meaningful use is now doing more harm than good, I see these events as positive developments. To understand why, we need to review the history of federal health IT policy, including the historical accident that gave birth to meaningful use.

I date the start of the modern era of health IT to January 20, 2004 when, in his State of the Union address, President George W. Bush made it a national goal to wire the U.S. health care system. A few months later, he created the Office of the National Coordinator for Health Information Technology (ONC), and gave it a budget of $42 million to get the ball rolling.